CCHIT Hits Its Half-Way Point

About 40 percent of the EHR market is currently certified by CCHIT (the Certification Commission for Healthcare Information Technology), with companies offering more than 85 CCHIT certified products suited for use in physician offices. Next month, CCHIT will publish work group environmental scans – a look at recognized standards, product availability and best practices – conducted as the first step to setting requirements for an expanded set of 2008 certifications. Digital HealthCare & Productivity recently spoke with Dr. Mark Leavitt, CCHIT chairman, about the commission’s progress and future plans.

DHP: Some critics have said that CCHIT is oversimplifying interoperability and the problem is much more complex than simply agreeing upon data standards. Far more complicated issues such as data aggregation, synchronization, ownership and communication protocols have yet to be tackled. What is your response to this?

Leavitt:  We’re a very practical organization; we believe that interoperability cannot be created from scratch. You can’t go from zero to total interoperability. There are some very simple things we can begin to do to save lives and money without waiting for a perfectly elegant solution. This year, systems for doctors’ offices will be able send refills or new prescriptions electronically — there are many other things that can be done with medication management but we decided to start with this. We start with something simple, then raise the bar and make it better; that’s our approach.

In 2008, the next step in interoperability is the ability to exchange a simple summary of records, an exchange of patient data moving between doctors’ offices, hospitals, and other entities. That will be a big accomplishment.

DHP: Are certification fees too high and perhaps a barrier to entry for small vendors, leading them to forgo certification and hope that physicians opt to try the free market for ambulatory products rather than rely on certified products, particularly if no legislation or other mandate requires that they use certified products? Fees might also prove a high barrier for larger vendors who have to certify many products.

Leavitt:  We have data demonstrating that 75 percent of the vendors now certified are small businesses. There is no evidence that our fees -- $28,000 for ambulatory certification -- are preventing small companies from getting certified. We decided to hold the line and keep fees the same for 2007, our second year. We haven’t determined future fees and can’t predict what they might be but, to be self-sustaining, we must cover the cost of the program: administering the application and testing process, paying jurors, examining documentation, and more.

Certification doesn’t take away the need for increased funding for health-IT, whether its government funding or incentives from private payers. But certification does support these new incentives for adoption by assuring payers that the products they are subsidizing will deliver the expected benefit.

DHP: CCHIT has made a lot of progress since 2005, when the commission received a three-year contract from the Department of Health and Human Services. At the halfway point, what are the commission’s accomplishments, and what lies ahead?

Leavitt:  We have received a number of endorsements from professional associations including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, Medical Group Management Association, and the Physician’s Foundations for Health Systems Excellence. These show good acceptance by the physician and provider community.

We’ve also gotten the support of the American Health Information Community (AHIC) --- a blue ribbon panel helping to set the agenda for national health-IT. Last month we presented the criteria for both ambulatory and inpatient EHRs to the Secretary of HHS and AHIC and it was accepted unanimously, which is a very strong confirmation that we’re doing good work.

We have started certifying ambulatory products for 2007, with seven products already receiving CCHIT certification and several more in the process. We have raised the bar significantly from the previous year’s criteria. Ambulatory EHRs now must include electronic prescribing, demonstrate an ability to receive lab results, and show enhanced patient safety, quality, and security features. We started taking application this month for inpatient EHR certifications.

There’s a great demand for certification in other areas, and we plan to expand to professional specialties, care settings, and patient populations, including emergency department, cardiovascular medicine, child health, behavioral health care, long-term care, and many more. The first three -- emergency department, cardiovascular medicine, and child health criteria -- will be ready for the next cycle of Ambulatory EHR certification beginning next July.

We are on track to be financially self-sustaining by the time the government contract is finished and we’re proud of what we’ve accomplished. We are on time and on budget to deliver the first two domains, ambulatory and inpatient, and are in the developmental phase for network. We will be publishing some early thinking on the certification of the networks over which EHRs operate on Sept. 13 for a 30-day public comment period.

DHP: There’s been talk that a company with a certified product recently went bankrupt, leaving some buyers in the lurch. Patrolling financial viability isn’t your purview but do you have any ideas on how to help prevent such problems going forward?

Leavitt:  This is a topic for active discussion at the Commission. In our message to doctors, we make it clear we are not examining financial viability but the product. Physicians should start with certified products as their short list and add their own due diligence in the areas of financial viability, after-sales services and support, and fit for their particular practice patterns. The Commission is concerned about companies’ ability to support the product, so currently we are discussing a way to make more transparent the track record of the companies from which physicians are buying. That might include a look at how long the company has been in the business, how many clients they serve, how many employees they have, etc. We may ask vendors to voluntarily respond, making that part of the company information we publish so physicians can make their own choice.

DHP: Any advice for vendors who are preparing for the certification process?

Leavitt:  The most common pitfall is lack of preparation. They need to look at the available criteria and test scripts at They should run through them and be honest as to whether they are fulfilling the criteria and can demonstrate the test steps. 

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